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배경 In sepsis, the systemic response systemic inflammatory response of the host to pathogens, host factors with poor prognosis include old age, frailty, and sarcopenia. Biomarkers to evaluate the diagnosis and severity of sepsis may be critical for adequate clinical decision and help improve the prognosis of sepsis. Among biomarkers, this study was conducted to evaluate the association between the myokine, cytokines produced and secreted by muscle cells, and the diagnosis and prognosis of sepsis, and also to evaluate whether myokine is associated with muscle mass. 방법 A prospective cohort study was conducted among adult sepsis patients who visited the emergency room of Korea University Ansan Hospital from January 2016 to January 2020. The myokines measured in this study were brain-derived neutrotrophic factor oncostatin M. Muscle mass index was measured by a board-certified radiologist on axial images of L3 vertebra level in patients underwent abdomen CT scan at the time of admission for sepsis. 결과 During the study population, 627 sepsis patients were included in the study. Of these, myokines were measured in 168 patients, and 66 patients (39.2%) were diagnosed as septic shock. The median SOFA score was 8 in sepsis group and 11 in septic shock group. The initial lactate levels were 2.5 and 5.6 mmol/L in sepsis and septic shock, respectively. In-hospital mortality rate was 39.3%, and the 7-, 14-, and 28-day mortality rates were 13.7%, 21.4%, and 26.8%, respectively. Among myokines, the median value of BDNF were 11.2ng/mL and 10ng/mL in sepsis and septic shock, respectively. The median value of oncostatin M were 102pg/mL and 111.6pg/mL in sepsis and septic shock, respectively. Total abdomi- nal muscle area index (TAMAI) were 34.6㎠/㎡ and 34.2㎠/㎡ in sepsis and septic shock, respectively. BDNF was statistically significantly different from sepsis (P < 0.001) and septic shock (P <0.001) com- pared with the control group, respectively. Oncostatin M in sepsis (P <0.001) and septic shock (P <0.001) were significantly different from the control group, respectively. Higher oncostatin M were asso- ciated with increased 14-day mortality (adjusted hazard ratio [aHR]: 1.01, 95% confidence interval [CI]: 1.00-1.02, P = 0.028) and 28-day mortality (aHR: 1.01, 95% CI 1.00-1.02, P = 0.010). BDNF at the di- agnosis of sepsis was statistically higher in survivors (12.15 ng/mL) than in deaths (8.19 ng/mL), where as oncostatin M showed no difference between the two groups. TAMAI showed higher value in the sur- vivors (35.23㎠/㎡) than in the deaths (30.6㎠/㎡). TAMAI did not show any association with myokines. 결론 In patients with sepsis and septic shock, BDNF was lower than that of healthy controls and oncostatin M was higher than that of healthy controls. Oncostatin M was associated with higher mortality in sepsis patients, and BDNF was significantly higher in sepsis survivors. Muscle mass did not show a significant association with myokine levels. [ABSTRACT FROM AUTHOR]

Since sepsis was first defined, sepsis management has remained challenging. To improve mortality rates for sepsis and septic shock, an accurate diagnosis and prompt administration of appropriate antibiotics are essential. The goals of antimicrobial stewardship are to achieve optimal clinical outcomes and to ensure cost-effectiveness and minimal unintended consequences, such as toxic effects and development of resistant pathogens. A combination of inadequate diagnostic criteria for sepsis and time pressure to provide broad-spectrum antimicrobial therapy remains an obstacle for antimicrobial stewardship. Efforts such as selection of appropriate empirical antibiotics and de-escalation or determination of whether or not to stop antibiotics may help to improve a patient's clinical prognosis as well as the successful implementation of antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

배경 Sepsis is still one of the infectious diseases represented by high mortality rates. Rapid and accurate diagnosis of sepsis is necessary for early administration of antibiotics to improve the prognosis of sepsis. This study was designed to improve the rapid diagnosis of sepsis among the large number of patients admitted to the emergency room. 방법 We developed “K-Speed: Korea University-Korea Institute of Science and Technology SePsis Early prEdiction and Diagnosis algorithm”, a high performance clinical decision algorithm for early diagnosis of sepsis by the application of deep learning technique. The study population comprised of patients with Korean Triage and Acuity Scale (KTAS) score of 3 or higher, who visited emergency room (ER) between January 2016 and January 2020, and were classified as sepsis, septic shock, and non-sepsis according to the final diagnosis. K-Speed analyzed a combination of clinical data including demographics, vital signs, and laboratory findings to generate a sepsis and septic shock risk score. 결과 During study period, a total of 1208 patients were enrolled in this study. From 4-fold cross validation, the Area Under the Receiver Operating Characteristic (AUROC) of K-Speed was 0.83 to distinguish between sepsis and non-sepsis patients among severely ill patients in ER and was higher than procalcitonin (0.73). The sensitivity, specificity, accuracy, precision, and F1 score were 0.77, 0.79, 0.78, 0.80, and 0.78, respectively. The AUROC of K-Speed was 0.78 for distinguishing between septic shock and others. The sensitivity, specificity, accuracy, precision, and F1 score were 0.97, 0.19, 0.81, 0.83, and 0.89, respectively. 결론 K-Speed, a high performance clinical decision algorithm via deep learning based on demographics, vital signs, and laboratory findings showed relatively high AUROC to predict the onset of sepsis. K-Speed may be useful for early diagnosis of sepsis and septic shock in ER. [ABSTRACT FROM AUTHOR]